First the good news. My wife and I each have M.D.s as well as Ph.D.s. (Yes, that is a bit crazy ... but we both really love what we do.) We're both in our mid-30s, having just finished school. I'm getting started teaching at colleges in the area and loving it, and I'm planning on shopping for a tenure-track job next year, with all evidence suggesting that I'll be a pretty hot prospect. My wife is pursuing her residency in general medicine, starting the second of three years and over the rather hellish hump; she's brilliant at it and loves it, and once she's done she'll be able to get a great, well-paying, reasonable-lifestyle job anywhere we go. We have a 2-year-old son whom we love madly. Deciding to have kids was a huge ordeal because a terrible genetic disease (Huntington's disease) runs in my family, so before getting pregnant I faced my terror and got tested -- and discovered that I don't have the gene. So I'll never get the disease, nor will our son. Basically, I've invested huge amounts of intellectual and emotional energy (and received a ton of luck) in working toward a really great life, and while things are good now, I feel like I'm right on the cusp of having a stable, intellectually and emotionally stimulating, and fairly stress-free life.
Sounds great, right? Now for the bad news. My mother and sister both live in the suburbs of Denver, which is where I grew up. My mother has always been extremely needy and basically unhappy; that's why I haven't lived there since I left for college. Since my dad died of Huntington's disease in 2000 she has become much worse, deeply depressed and physically sick. She's hospitalized every six months for a variety of illnesses (she's 62); so far she has always bounced back, but pretty soon she's going to need round-the-clock medical care. Even worse, my sister's health has started to decline. She had a terrible back injury two years ago and hasn't been pain-free since. Her husband is a decent guy, but he travels for weeks at a time for work and doesn't know how to support her when he's home. (I'm not sure I could if the roles were reversed.) If things get a lot worse I expect they might divorce. Her kids (5 and 3) are becoming increasingly miserable (of course). Also, my sister hasn't been tested for Huntington's disease, so she has a 50 percent chance of getting it (symptoms typically appear in the 40s), and if she's positive her kids could get it too, a fact that haunts her. Finally, both my mom and my sister are in money trouble, though not serious -- yet.
I guess my dilemma is clear. My wife and I could get good jobs wherever we wanted to go -- including Denver. I would be able to offer significant help, in both time and money, if I were there. In spite of their flaws (and Lord knows I have my own) I am quite fond of both my mom and my sister, and their relationship is extremely important to me. Nevertheless, I'm pretty sure that if I lived in Denver their profound unhappiness would seep into every crevice of my home life. When we're all together, I feel like my mom and sister constantly try to test where my loyalties lie, and the worse they get the more acute the tension becomes. But given that I may be their only hope, am I not obligated to help?
The Ungrateful Son
Dear Ungrateful Son,
Since you signed your note as the "Ungrateful Son" I want to say that I recognize how you probably worry in this way, but I don't think you are really the ungrateful son at all. I think you are someone who had to get away from a toxic situation in order to develop fully. If you had tried to stay in the area, the influence of your mother and your sister might have been enough to undermine you and bring you all down. So you wisely got away when you needed to. You made a plan and carried it through and now you are strong and capable enough that you can do anything you like. You could choose an exotic locale and try to ignore your mother and sister, but I do not think that would work out well. As I have said before, your true home is not the place you choose, but the place that chooses you. So I suggest that you choose now to move to Denver and be of service to your mother and sister. Rather than a sacrifice and a waste, I think that is the route to a fulfilling, happy life.
Here is what I envision for you: I envision a big house near your mother and sister, with ample space for them to visit and perhaps stay with you if they are ill -- a place with good separation of living spaces and, if possible, a guest house. A place that is easily accessible for medical equipment. A place where your sister's children can be welcome and can be good cousins to your son.
I think staying in Denver is your most rational decision. It is hard to enjoy paradise when our loved ones are sick and far away. That is simply a fact. It would be nice if you could pick the most wonderful place in the world and go there and forget about your mother and your sister. But you can't. You won't be able to. You will be tortured. You will have to take valuable time out from your profession in order to fly to your hometown and tend to matters there. It will make your life, I am afraid, a living hell. So why not do the smart and easy thing: Buy a big house near your mother and sister.
Rather than distance yourself physically, I would try to eliminate the distance, in order to create the most efficient setup. But then, within that setup, I would try to build in as much privacy and isolation as possible, so that, say, as your mother ages and becomes more ill, perhaps she could stay in the guest house and you could get help for her.
It will be good for your 2-year-old son to have some older cousins to play with. Your mother and your sister could both provide childcare. The presence of family can be healing. Your mother will probably do better health-wise with family and grandchildren around. Playing a role in childcare will give her a reason to live and thus may help somewhat in easing the parts of her depression that center around a feeling of worthlessness, loneliness and hopelessness.
As to your desires to enjoy the fruits of your labors, which ought to be substantial: If you live near your mother and your sister, it is possible that you will be able to fly away and have your son cared for in your own home by one of them when you go, or travel with your son and have one of them stay in and look after your beautiful home.
And should either or both of them become acutely ill, it will be much, much easier to care for them in your hometown, where you know the doctors and the hospitals, and where you do not have to conduct long phone conferences and travel to a distant city.
This is not all about being the good son. It is also about establishing a professional persona. Medicine, after all, is a fascinating science and a lucrative career but it is before all that a role of service to humanity.
Being a professor of medicine is an opportunity to set an example for future doctors. If you do not make caring for sick family members a priority, you are implying that you are exempt from this ethos of caring for others. It may look as though you consider it just a smoke screen for ambition, that while it may be fine for some, for you it does not apply. Or you may appear to be a brilliant but selfish Dr. House.
I do not think that is what you want to teach your students. I think you will want to teach them how to live as doctors in this world, to demonstrate the difficult real-world choices a doctor faces, and how a good doctor makes those choices. So you would be wise to conduct your life in a way that exemplifies the highest values a doctor can aspire to. This is not simply idealism; those who consider hiring you may have some old-school values, and may choose to evaluate you not just as a scholar and doctor, but as a person whose values will affect your students and the institution you work for.
If you make this decision to stay in Denver to help care for your mother and sister, you are exemplifying something good and deep and true, something worth passing on to future doctors.
So I would find a good house and plan to stay in this house for the next 15 years, ready and able to deal with whatever happens. Then, in 2022 or so, when you are in your 50s and your mother is approaching 80, assuming she lives that long, your son and your sister's kids will be in college and things will change. Your sister by then may have been divorced and remarried and she will be on her own, or perhaps she will no longer be with us. You will be approaching a time where you may be able to sever ties again. By that time, you will probably be a tenured professor and your wife will be an eminent and respected doctor. You will be able to do pretty much anything you damn well please, with a clear conscience. It will have cost you dearly, both financially and emotionally, to live in Denver and take care of your mom and your sister. But I think you will have few regrets, because you will have done the right thing. You will have exemplified the spirit of service at the core of a doctor's calling. You can then go to Bermuda or Sri Lanka or Palm Springs or wherever you like.
But for now, a doctor is needed in Denver.
What? You want more?